Hospitalists -- physicians who manage inpatient care -- should work closely with patients' primary care physicians (PCPs) particularly when sensitive issues arise using the hospitalist model of care, according to UC San Francisco researchers.

In an article published in the July 14 issue of the Journal of American Medical Association (JAMA), UCSF researchers explore ethical issues that arise when using the hospitalist model of care and suggest ways to ensure ethical protections for patients, such as confidentiality, shared medical decision making, and patient autonomy.

The hospitalist is a departure from the way doctors have traditionally functioned in hospitals. In the past, patients' PCPs would manage their inpatient care, however, with the hospitalist, the PCP no longer provides care for hospitalized patients.

"Not only should hospitalists work with PCPs but they also need to develop relationships of trust with patients to lessen ethical concerns," according to Steve Pantilat, MD, UCSF assistant clinical professor of medicine, UCSF hospitalist at UCSF Stanford Health Care, and faculty member in the UCSF program in medical ethics.

The emergence of hospitalists is based on the idea that inpatient care specialists will improve the quality of care, increase the efficiency of care, and be more available to hospitalized patients than primary care physicians, said Pantilat.

Currently there are 3,000-4,000 hospitalists, and in the future there will be as many as 20,000, which means a majority of Americans may be cared for by hospitalists, said Pantilat.

One downside to using hospitalists, according to Pantilat, is that patients experience discontinuity of care. Patients are suddenly cared for by doctors they don't know at a time when they are most sick.

This discontinuity or disruption in care, he added, raises several ethical concerns.

The promise of confidentiality between a patient and primary care physician may be compromis
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Contact: Lordelyn P. del Rosario
Ldelrosario.@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
26-Jul-1999